The liver looks like an ultrasound. Ultrasound of the liver - what does it show? Indications, preparation, norm (indicators, sizes), interpretation of results, price

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Ultrasound and inflammation

1. Abnormal liver tests (indicates decreased function).
2. Jaundice (yellowing of the skin and mucous membranes).
3. Injuries and diseases of the abdominal cavity.
4. Problems with the gallbladder.
5. Assumption of the oncological process.
6. Feverish state of unknown nature.

Typical but not specific

• Size increase.

• Decreased echogenicity.

• Prominent blood vessels.

Dangerous "hron"

1. A marked increase in the size of the liver (both lobes).
2. The appearance of irregularities of its edges, the fuzziness of their contour (a characteristic sign of cirrhosis).
3. Rounding of the lower edge, increased tissue echogenicity (progression).
4. Heterogeneity.
5. Gradual depletion of the vascular pattern.
6. The decrease in sound conductivity indicates the growth in the parenchyma of dense connective tissue, which is poorly conductive to the knot-wave.

Many patients are interested in whether it is possible to accurately establish the diagnosis on ultrasound of the liver with hepatitis C? The liver is one of the main organs of the human body. Its task is to remove accumulated toxins and harmful substances from the body that threaten human health and life. But it so happens that she herself is in danger. One of the most formidable diseases of this important organ is hepatitis C. The main method for diagnosing hepatitis is an ultrasound of the liver, which is indicated at the slightest suspicion of this disease.

When is ultrasound prescribed for hepatitis C?

This diagnostic method is very informative, absolutely safe and painless. Ultrasound of the liver allows you to detect even minor changes in the organ and make an accurate diagnosis. An ultrasound scan of the liver shows the doctor the extent of the infection, the general condition, the functioning of the organ, and the nature of the lesion.

If hepatitis C is diagnosed, then the patient is assigned an additional ultrasound with color Doppler mapping. This kind of ultrasound allows specialists to trace the work of the vessels that feed the gland, the blood flow in dynamics. This method makes it possible to track the movement of blood through the vessels of the liver in real time and in a color image.

A diagnostic specialist will see the direction of fluid movement and speed, as well as track places where there is no blood supply. Ultrasound combined with color Doppler imaging is one of the most informative, popular and common types of liver disease diagnostics. To form a complete picture of the nature and extent of the disease, in addition to ultrasound, a patient's blood test is prescribed.

What does ultrasound show?

The patient usually complains of:

• malaise;
• nausea;
• pain in the joints;
• yellowness or gray tint of the skin and whites of the eyes;
• odor from the esophagus;
• bitterness in the mouth;
• loss of appetite;
• feeling of heaviness;
• pain in the side (not always).

In this case, the doctor may suspect hepatitis C and prescribe an ultrasound of the abdominal organs. But these symptoms do not always indicate this disease. Ultrasound can accurately determine the presence or absence of a viral infection or other liver pathologies. The following diseases can be determined by ultrasound:

• hepatitis C (its acute or chronic form);
• liver tumor;
• various hematomas and hemangiomas;
• the presence of cysts;
• cirrhosis.

Since the liver is closely connected by vessels with such an abdominal organ as the gallbladder, a liver scan can reveal cholelithiasis or cholecystitis.

Moreover, with a disease such as hepatitis C, the condition of the gallbladder plays an important role, therefore, if this pathology is suspected, it is also examined. With hepatitis, problems with general health are often associated with the functioning of the gallbladder. Such a symptom as pain in the pathology of the gland rarely appears, but the gallbladder signals with pain about violations in the diet. Cholecystitis can be a consequence or a complication of hepatitis C, which will require separate treatment.

What does ultrasound show in hepatitis? Ultrasound of the liver can help diagnose the various stages of hepatitis C and cirrhosis. The monitor shows what the liver looks like, its size, density, foreign inclusions and other various parameters of the organ. Each of the diseases, including hepatitis C and its various stages, has its own special ultrasound signs.

The results of this study can be seen:

1. In acute hepatitis C, ultrasound shows a slightly enlarged organ, its surface is smooth and even. Several foci of necrosis are visible, foci of fatty degeneration are detected. The blood flow is clearly visible, which is not disturbed.
2. Chronic hepatitis on ultrasound is determined by the following indicators. A large number of foci of necrosis. The liver tissue is almost destroyed, in its place - overgrown connective tissue. Fibrous bands are visible.
3. With cirrhosis of the liver, ultrasound will show circulatory disorders, varicose veins and the formation of additional vessels, through which some of the blood circulates, bypassing the gland.

Thanks to ultrasound diagnostics, it is possible to diagnose hepatitis at an early stage and begin treatment immediately, without waiting for complications and cirrhosis. The main thing that ultrasound can show in the initial stage of the disease is that the size of the liver in hepatitis immediately becomes enlarged.

But the danger and insidiousness of this disease lies in the fact that in the early stages it is most often asymptomatic, although inflammation in the liver due to infection is in full swing.

Disturbing signs may appear only in the later stages of the disease: with an exacerbation of chronic hepatitis C or cirrhosis of the liver. Therefore, it is recommended to be examined regularly in order to monitor the condition of the liver and the behavior of the viral infection.

How to prepare for an ultrasound of the liver?

In order for the ultrasound readings to be as accurate and informative as possible, you should properly prepare for the procedure. In this case, it is recommended to refrain from eating for several hours. In order to free the abdominal cavity from excess gases, you should not consume the following products within 3 days before the procedure:

• legumes;
• milk;
• carbonated drinks;
• fresh vegetables;
• cabbage.

The day before the study, a cleansing enema should be performed (especially for those patients who are overweight). In each case, the doctor may recommend taking any other measures in order to properly prepare for ultrasound in hepatitis C.

How is the research going?

Ultrasound of the liver is performed with an ultrasonic sensor. The patient should lie down, hold his breath. At this time, the doctor, passing the sensor over the abdomen, receives data on the organ under study on the monitor screen.

The real-time screen reflects the state of the liver of the subject, its structure, size and other parameters. Most often, 2D ultrasound is used in the study of the liver. This device displays a two-dimensional, flat black and white picture on the screen, which has a height and length. Recently, three-dimensional ultrasound devices - 3D and 4D - are becoming more and more widespread.

Both of these types of research differ from the previous one in volumetric image and color. They differ from each other in that a 3D picture shows a three-dimensional image of an organ from one point of view. When conducting a 4D study, the doctor can expand the three-dimensional image of the organ and examine it from all sides, so the parameters of the liver will be visible very well.

When is 3D and 4D examination indicated? Sometimes a two-dimensional ultrasound is enough to make an accurate diagnosis, but there are times when the diagnosis needs to be clarified, supplemented or confirmed. Before a planned surgical intervention, a three-dimensional ultrasound is indicated.

Preparation for such an ultrasound should be thorough, in compliance with all of the above recommendations and one more important point: if an X-ray examination was performed the day before, then it is necessary to inform the doctor about this, as the results may be distorted.

Hepatitis C is an inflammatory disease of the liver of viral origin, transmitted through the blood, occurring in an acute or chronic form, often having a severe course and often ending in incurable consequences.

Ultrasound examination of the hepatobiliary system is a necessary procedure in the diagnosis of liver diseases. What ultrasound signs of liver inflammation exist and is it possible to detect hepatitis C on ultrasound?

Ultrasound is a highly informative diagnostic method that modern medicine offers us. Serves as an assessment of the state of internal organs, helps to determine the exact diagnosis and makes it possible to monitor the effectiveness of the treatment process. Ultrasound examination is widely used in diagnosing liver pathology.

The liver is an unpaired parenchymal organ and consists entirely of hepatic tissue. The basis of the parenchyma are glandular lobules, which are surrounded by blood collaterals and bile ducts. Healthy tissue on ultrasound looks like a homogeneous, weakly echoic structure, against which vessels and ducts are clearly visible.

The size and density of the organ allow it to reflect ultrasonic waves well, so it is perfectly scanned by an ultrasound machine. To assess the inflammation that occurs with hepatitis, its parameters, wall thickness are measured, the structure of the parenchyma and the state of blood flow are assessed. Ultrasound examination is necessarily included in the complex diagnosis of all hepatobiliary pathologies.

Indications for ultrasound examination of the hepatobiliary system are:

Abnormal liver tests (indicates decreased function). Jaundice (yellowing of the skin and mucous membranes). Injuries and diseases of the abdominal cavity. Problems with the gallbladder. Assumption of the oncological process. Feverish state of unknown nature.

Ultrasound detects diffuse changes, including: fibrosis, hypertrophy, sclerosis, parenchymal edema or dystrophy. Such manifestations are characteristic of a number of pathologies, therefore, ultrasound examination fully complements the idea of ​​the state of health.

Ultrasound helps to identify various abnormalities

What are the ultrasound signs of hepatitis and is it always enough to make a diagnosis of one ultrasound examination?

Viral damage leads to inflammation of the liver tissue and functional disorders. Depending on the etiotropic cause and severity of inflammation, the symptoms may be pronounced (acute) or be blurred (chronic). The inflammatory process leads to swelling of the organ and its increase in size, the spleen increases.

On ultrasound, this will manifest itself in a decrease in echogenicity (the ability to conduct ultrasound). On the monitor screen of the device, the inflamed edematous gland will look dark or almost black (depending on the degree of inflammation).

The acute form of the disease proceeds with typical bright symptoms: fever, pain in the right hypochondrium, dysfunction.

The main symptom of acute hepatitis C is yellowing of the skin and mucous membranes, a characteristic increase in the blood of endogenous enzymes ALT, AST and the bile pigment bilirubin, the culprit of "yellowing". There are specific markers of hepatitis C.

Can acute hepatitis C be seen on an ultrasound of the liver?

It can be assumed: ultrasound will show an increase in the inflamed organ due to its edema, this sign is typical, but not specific. A similar picture can be provoked by completely different problems. The onset of the disease, its mild course, may not be reflected on the monitor of the ultrasound machine.

The diagnosis of acute hepatitis C is made on the basis of clinical complaints, examination of the patient, history taking and results of biochemical tests.

What does chronic hepatitis C look like on ultrasound?

Is it possible to draw a conclusion about chronic inflammation of the liver based on the results of an ultrasound examination? Theoretically, it is possible, but not always, the initial lesion of the gland by such a study is not always possible to see, additional analyzes are needed.

Additional tests are needed to accurately diagnose the disease.

In some forms of the disease, the liver may slightly increase, but its tissue remains unchanged. Considering that some parameters depend on gender, age, height and constitution, a moderate increase at the beginning, without diffuse changes, can be taken as the norm.

The chronic form often has a latent course and manifests itself when changes in the structure are already quite pronounced and visible on ultrasound.

What is the purpose of ultrasound in viral hepatitis?

In order to determine the state of the organ at this moment, the progression of the disease or to make a conclusion about the effectiveness of the treatment.

If focal compaction is noted, fibrous-modified areas of tissue, unevenness and tuberosity of the liver, suggest the onset of cirrhosis.

Increased echogenicity (light liver) indicates fatty degeneration of the hepatic parenchyma. fatty hepatosis.

During the study, the parameters are evaluated: the shape, size, structure and condition of the ducts and hepatic collaterals.

The results obtained are compared with the standards and a conclusion is made.

We list the main ultrasound points suggesting hepatitis.

Size increase.

An unstable and non-specific sign, at the beginning of the disease and with a mild course of the disease, the dimensions may not change. An increase in the organ can be observed in other pathologies, in particular heart disease and vascular disorders. The acute form of the disease is characterized by an increase in the right lobe.

One of the signs of hepatitis is an enlarged liver

Decreased echogenicity.

A characteristic, but non-specific indicator indicating swelling of the inflamed organ. On the monitor, this is manifested by a darkening, in the conclusion it will be noted by the phrases: hypoechogenicity or anechogenicity (black liver). A similar phenomenon is observed in chronic heart failure (congestive liver).

Heterogeneity of the hepatic parenchyma.

It does not always indicate viral hepatitis, such changes may indicate sclerosing cholangitis, fatty transformation of the liver tissue, cirrhosis and autoimmune hepatitis.

Prominent blood vessels.

The consequence of edema of inflamed tissues, against the “dark” background of which the vessels become clearly visible, is a frequent but not constant indicator.

The chronic form occurs imperceptibly, at the beginning of the disease there are practically no symptoms. On ultrasound, the liver looks normal, no abnormalities in its structure are observed. There may be a slight increase in size, which is not a reason for the diagnosis. In this case, biochemical research is important.

The appearance of visible signs of "chronic" is observed with the further progression of the viral infection. The cause for concern is the identification during the study of ultrasound:

A marked increase in the size of the liver (both lobes). The appearance of irregularities of its edges, the fuzziness of their contour (a characteristic sign of cirrhosis). Rounding of the lower edge, increased tissue echogenicity (progression). Heterogeneity. Gradual depletion of the vascular pattern. The decrease in sound conductivity indicates the growth in the parenchyma of dense connective tissue, which is poorly conductive to the knot-wave.

On the basis of a single ultrasound examination of the liver, it is impossible to diagnose hepatitis C; for a final conclusion, an examination and questioning of the patient and important biochemical studies of his blood are necessary. The definition of a certain type of virus must be confirmed by laboratory methods, including PCR (polymerase chain reaction) analysis.

the sizes of each lobe of the echogenicity of the contours of the liver of its structure.

Spots on the liver - this term says that foci are found in the tissue in which the echogenicity of the liver is increased. This may indicate in favor of areas of helminthic invasion (giardiasis). To clarify the diagnosis in this case, it is recommended to undergo computed tomography. Compaction in the liver is also a purely sonological diagnosis. He says that there are areas in the tissue that can be both nodes of incipient cirrhosis and tumors.

Signs of diffuse changes

if ultrasound was done in the acute period, there is an increase in the liver itself, an increase in its density, a violation and heterogeneity of the structure, signs of chronic hepatitis: enlargement of the liver, heterogeneity of its structure, ambiguity of the vascular pattern.

autoimmune hepatitis, sclerosing cholangitis, hepatitis of any etiology, cirrhosis.

the liver can either be larger or smaller (depending on the stage of the disease): first, the left lobe increases, then the caudate, then the liver begins to decrease; there are regeneration nodes inside, due to which the structure is mosaic; in cirrhosis, both the spleen and the diameter of the portal vein increase roundness, tuberous structure, the corners of the liver are dilated.

total and direct bilirubin fractions, ALT and AST enzymes, gamma-glutamyl transferase, alkaline phosphatase.

to smooth muscles to parietal cells of the stomach to microsomes of the liver and kidneys to mitochondria.

Hepatitis C is a viral disease transmitted by contact. The disease is characterized by a mild or acute form, which can provoke the development of a chronic form, as well as severe incurable consequences.

Diagnosis of this complex disorder is based not only on a blood test for the presence of markers, antibodies, determination of the level of bilirubin, but it is also necessary to conduct an ultrasound and computer examination.

In more severe cases, direct examination of the patient's liver tissue is required.

HBCAg is the main marker of hepatitis C. But in addition to this marker, a number of relevant antibodies can be detected, the presence of which may indicate the exact likelihood of developing the disease.

It should be noted that even if hepatitis C markers were detected in a single case during the diagnosis, this does not indicate the presence of an acute or chronic disease.

To get a more detailed picture, you need to contact an infectious disease specialist, who, after prescribing appropriate tests, samples and examinations, will be able to establish an accurate diagnosis.

Before starting the diagnosis, you should take into account all the symptoms and the general condition of the body.

If yellowness is noted on the body, this is the first sign of a liver malfunction (yellowness of the skin and sclera). This is due to the fact that the level of bilirubin (yellow pigment) occurs due to the breakdown of red blood cells. A normally functioning liver independently utilizes bilirubin from the body, but if its work is impaired, it cannot fully perform its function, and, therefore, the yellow pigment is not filtered out. Darkening of urine, as an excess of bilirubin is trying to be disposed of by the kidneys. The disease is accompanied by ailments, fatigue, pain in the right side, hypochondrium, abdomen, fever and poor appetite. Skin itching is often observed, which appears due to intoxication of the body, i.e. the liver can not cope with incoming toxic substances. Also taken into account are diseases that the patient previously had, especially hepatitis. The hereditary factor is checked. Also taken into account is the abuse of alcohol, the intake of certain medications uncontrolled by the doctor.

Due to the fact that the virus of the disorder was discovered recently, the diagnosis of hepatitis C, namely its virus provoking development, has not been thoroughly developed, therefore the main diagnostic factor is the presence of antibodies belonging to group C.

To determine the presence of antibodies at the moment allows the immunosorbent test and the RIBA test (immune recombinant stains). Basically, the first test is used in medicine, since the second one requires a lot of money.

To get a more accurate picture of what is happening, the doctor must prescribe a blood test and a series of examinations (ultrasound, CT scan of the liver, radioisotope scanning, liver samples, determination of serum enzymes, sometimes a biopsy), which are discussed further.

Ultrasound of the liver in hepatitis C is one of the main instrumental examinations, which is prescribed by a doctor, thanks to which it is possible to examine the condition of the liver and bile ducts.

Ultrasound is a painless procedure that takes a little time, but is able to show even minor violations of the organ, and based on the results of which a decision is made about further manipulations.

On the eve of this diagnostic procedure, it is recommended not to eat for six hours, because that is how much time is needed to fill the gallbladder, which is the only way to see it.

The study shows the size of the organs and bile ducts, their location, the presence of calculi and blockage. Also, thanks to this, it is possible to determine the blood flow of the liver, to examine the kidneys, bile and spleen.

CT is a widely used diagnostic method, with which you can get a three-dimensional view of the liver, blood vessels adjacent to it, the gallbladder and its channels, kidney, pancreas, spleen.

This simple examination, which takes a little more than half an hour, allows you to instantly determine the presence of tumors, cysts, and mechanical damage.

Before the procedure, it is forbidden to eat food for 12 hours.

Before starting, you should drink a special solution with a radiopaque substance, which improves the visibility of the organs.

To date, this is the most informative procedure in which radioactive isotopes are introduced to the subject, which help to examine the bladder and track the movement of bile.

Thanks to a special device, you can get a picture that resembles an X-ray image, on which you can determine the state of the organ, as well as its diseases, such as cirrhosis or malignant neoplasms.

The dosage of isotopes introduced into the body is very small and cannot cause harm.

Liver tests show the adequacy of treatment, and make a prognosis of the disease, as well as determine liver disorders.

The level of alkaline phosphatase, bilirubin, serum enzymes, transaminases, albumin, as well as factors of the blood coagulation system is established, this allows you to determine the degree of liver damage.

Liver tests also help to detect cancer of the pancreas, bile ducts, the presence of stones or damage to the channels.

Biopsy

A biopsy is an effective method for diagnosing hepatitis C, which is carried out exclusively by a specialist in a hospital.

A small piece of liver tissue is removed with a special needle, which is sent for a histological examination conducted in a special laboratory.

Before starting the procedure, the patient must be given an anesthetic to minimize discomfort and eliminate pain. Upon completion, the patient needs to stay in the hospital for a few more hours for medical observation.

As a rule, an ultrasound and CT scan are performed with a biopsy so that the doctor can see the injection site of the needle, this eliminates complications.

A biopsy is used in the diagnosis of chronic hepatitis, which can be distinguished from other liver disorders that are provoked by excessive consumption of alcoholic beverages, uncontrolled intake of certain drugs, and impaired metabolism.

Using this procedure, it is possible to determine primary liver cancer (occurs directly in the organ) and secondary (introduced into the organ from others), a chronic form of hepatitis, hemochromatosis and other liver diseases. It can also be used as an organ control after treatment and for prognosis.

Deciphering an ultrasound of the liver will help you figure out what these or those terms written by the doctor who examined your liver mean. A full interpretation of the results, taking into account your symptoms and objective data, the prognosis and treatment is determined by the doctor.
It can be an infectious disease specialist, an oncologist, a gastroenterologist, an internist or a surgeon).

How preparation for ultrasound of the liver is carried out is described in detail in the corresponding section, it does not present much difficulty.

Only according to the ultrasound scan of the liver, therapy is not selected.

Preparation and methodology of the study

A little about how this type of ultrasound diagnostics is done. You come to the office, lie down on the couch, and lift your clothes so that the chest area and abdominal wall are free for examination. A gel is applied to the hypochondrium area on the right, along which the sensor will move. It shouldn't cause any discomfort at all.

Interpretation of normal results

The norm of ultrasound of the liver includes indicators:

• the size of each share
• echogenicity
• contours of the liver
• its structures.

For ease of inspection, according to some anatomical landmarks, 8 segments of the liver are distinguished. They evaluate all of the above parameters, compare them with the norm. When an organ pathology is detected, it is indicated in which segments it is found.

What diseases can ultrasound detect?

Let's talk about what the study shows. With its help, such changes in the tissue of the organ are detected:

Signs of focal liver lesions

Here is a breakdown of the most common terms that the sonologist indicates in the conclusion of the study.

Areas of calcification

Liver calcification. This word denotes a dense area in the parenchyma, impregnated with calcium salts. Such formations can appear as a result of infectious diseases (malaria, amoebiasis, tuberculosis), which in the active phase did not affect the entire organ, but formed foci of inflammation in it.

cavity formations

First of all, this is a liver cyst, that is, a rounded benign formation in one of the lobes that contains fluid inside (more often transparent, but can be filled with blood, bile or pus).

There are single and multiple cysts (they fill 30% or less of the liver tissue), there is also a congenital polycystic liver disease, when about 60% or more of the organ tissue is filled with cysts.

There is also the concept of "false cyst", when the wall of the cyst is not a thin film, but a tissue scarred due to rupture, removal of a cyst or abscess.

Frequent ultrasound diagnoses

These are the terms that doctors of ultrasound diagnostics call the echo characteristics of changes, by which “in life” one can understand several diagnoses:

1. Spots on the liver - this term says that foci are found in the tissue in which the echogenicity of the liver is increased. This may indicate in favor of areas of helminthic invasion (giardiasis). To clarify the diagnosis in this case, it is recommended to undergo computed tomography.
2. Sealing in the liver is also a purely sonological diagnosis. He says that there are areas in the tissue that can be both nodes of incipient cirrhosis and tumors.

Tumors of the liver

1. Liver cancer. It looks like a section of the parenchyma of an unusual structure, which has fuzzy boundaries, a heterogeneous structure, combined from areas of different echogenicity. Such a site is often difficult to notice against the background of cirrhotic changes in the liver, but here a doppler comes to the rescue: in this zone, a deformed network of vessels is noted or it is not visible at all. Enlarged lymph nodes also speak in favor of the malignancy of the formation, in the later stages - a displaced gallbladder, right-sided pleurisy, and a decrease in intestinal mobility.
2. Metastases. From what organ they are, it is impossible to determine by ultrasound. They can have either a smaller, compared with the liver tissue, density, or a greater one. Their distinguishing feature is a hypoechoic rim around the metastatic focus.
3. What does a liver hemangioma look like on ultrasound? This formation is hyperechoic, usually located near the vascular structures, has clear boundaries and an acoustic track. Clarify the diagnosis by computed tomography, angiography.

Signs of diffuse changes

Below we will briefly describe the signs of those diseases that cause changes not in individual areas, but over the entire surface of the liver.

Signs of Hepatitis C

The diagnosis of viral hepatitis, and even more so certain hepatitis (A, B, C) by ultrasound is not made. In hepatitis C, the following changes can be described:

• if the ultrasound was done in the acute period, there is an increase in the liver itself, an increase in its density, a violation and heterogeneity of the structure
• signs of chronic hepatitis: liver enlargement, heterogeneity of its structure, ambiguity of the vascular pattern.

What is "diffuse change"?

If diffuse changes in the liver are described on ultrasound, this means that the parenchyma of this organ has been changed throughout its entire length due to fibrosis, hypertrophy, sclerosis, dystrophy or swelling. That is, this is not a diagnosis, but a symptom that can occur in such diseases:

• autoimmune hepatitis
• sclerosing cholangitis
• hepatitis of any etiology
• cirrhosis.

What does cirrhosis look like?

There are such signs of liver cirrhosis on ultrasound:

• the liver can be either larger or smaller (depending on the stage of the disease): first, the left lobe increases, then the caudate, then the liver begins to decrease
• there are regeneration nodes inside, which is why the structure is mosaic
• with cirrhosis, both the spleen and the diameter of the portal vein increase
• the edges of the organ become rounded, bumpy structure
• the corners of the liver are dilated.

The diagnosis is made not only by the echographic picture, but also by the symptoms presented by the patient. For the first time, cirrhosis of the liver can be suspected (and confirmed by ultrasound) by the presence of ascites, that is, free uninfected fluid in the abdomen.

What does it mean if you have a light liver on an ultrasound scan?

A light liver is an increase in the echogenicity of the organ. This picture suggests that areas have appeared in the tissue that do not transmit ultrasound well (usually these are fat cells). If fatty degeneration of the organ occurs, the ultrasound doctor may write “white liver” in the conclusion.

Questions and answers about detecting liver problems

Q: What is liver screening?

A: This is the detection of people at risk for developing cancer, based on the results of tests for alpha-fetoprotein, as well as ultrasound data. It is carried out in patients with chronic forms of hepatitis B and C, with cirrhosis of the liver, as well as in countries where there is a large number of patients with liver cancer.

Q: What does "liver laboratory screening" mean?

A .: This is what is colloquially called liver tests - that is, an analysis of venous blood, in which such substances are determined:

• total and direct fractions of bilirubin
• enzymes ALT and AST
• gamma-glutamyltransferase
• alkaline phosphatase.

Q: What does screening for autoimmune liver disease mean?

A: This is also a type of vein test that helps identify autoimmune hepatitis and the second autoimmune disease, primary biliary cirrhosis. The following types of antibodies are determined in the blood:

• to smooth muscles
• to the lining cells of the stomach
• to liver and kidney microsomes
• mitochondria.

Elevated levels of these tests indicate that autoimmune hepatitis is present in this case. Also with the help of some specific levels it is possible to determine the type of disease.

Q: When and why is a liver puncture performed under ultrasound control?

A: Ultrasound determines where to insert a needle to collect suspicious cellular material for a malignant tumor. While the needle enters the node, they watch how the ultrasound picture changes (hemangiomas, that is, benign formations, tend to disappear during puncture).

Where to get researched

An ultrasound of the liver can be done at a polyclinic or public hospital in the community for little or even free of charge. To do this, you need to get a referral from your doctor.

You can also undergo this type of diagnosis in a multidisciplinary center or a private ultrasound diagnostic room. Its price ranges from 700 to 1200 rubles, while in the reviews people write that where the study is more expensive, it will not necessarily be better: it all depends on the specialist who performs it.

Thus, deciphering the ultrasound of the liver is an important step in conducting this study. It is on her that the further tactics of examination, treatment and evaluation of the effectiveness of the prescribed therapy depend.

ATTENTION! The information on the site is for reference or popular, is for informational purposes only. Proper treatment and prescribing of drugs can only be carried out by a qualified specialist, taking into account the diagnosis and medical history.

Successful diagnosis and treatment, health and well-being! Your uzilab.ru.

The liver is an internal organ that performs one of the most important functions in the human body. It helps to eliminate toxins formed during the breakdown of substances entering the body, and is also responsible for the energy balance and synthesis of biologically active substances.

Ultrasound is used to diagnose such pathologies of this organ as hepatitis. Ultrasound of the liver with hepatitis helps to detect all changes in the work of this body. This examination method is very informative, safe for health and absolutely painless.

Indications for research and diseases detected by ultrasound

Such diagnostics should be carried out not only if hepatitis is suspected, it helps to detect other liver pathologies. Indications for ultrasound of the liver are as follows:

Suspicion of an abscess;
Abdominal trauma;
Monitoring the course of treatment;
preventive goals.

Ultrasound diagnostics reveals the following diseases:

Acute hepatitis and its chronic form;
tumors;
cysts;
Cirrhosis of the liver;
Hemangiomas and hematomas.

With the help of ultrasound, all changes in the structure of the liver are determined, which allows the doctor to determine the presence or absence of hepatitis. For complete certainty, a blood test is performed, which provides additional data necessary to establish an accurate diagnosis.

Preparing for an ultrasound of the liver

Before the examination, refrain from eating, especially if it is planned in the morning. You should also free the intestines from gases to prevent interference during the ultrasound. To do this, follow a special diet for 3 days. Give up foods such as beans, peas, milk, fresh vegetables, cabbage, carbonated drinks.

Ultrasound examinations can be difficult for overweight patients. Therefore, a day before the diagnosis, they are recommended to conduct a cleansing enema (in the evening and in the morning). For more information on preparing for Ultrasound of the liver with hepatitis you get from your doctor.

How is an ultrasound of the liver performed?

Diagnosis of this organ is carried out using a special sensor. The patient should exhale and hold the breath. The doctor moves the sensor along the abdominal cavity and receives the results on the monitor screen. Thus, he sees in real time the left and right lobes of the liver and can examine their structure in detail.

Based on such an examination, the doctor writes a conclusion in which he indicates all the data on the size of the liver, its structure and other indicators. These data will allow you to accurately determine whether the liver is susceptible to hepatitis or not. You can undergo a complete examination of the liver if hepatitis is suspected in our center "Moscow Doctor". We have been in the diagnostics of internal organs for more than 1 year. Thanks to the high-class equipment that is used in our center, scanning reveals all deviations in the functioning of internal organs with 100% accuracy. Contact us at any time convenient for you, we will always be happy to help you.

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Main Symptoms

1. Jaundice. The symptom is common and is due to the fact that bilirubin enters the patient's blood during liver damage. Blood, circulating through the body, carries it through the organs and tissues, staining them yellow.
2. The appearance of pain in the region of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to the appearance of pain, which is dull and prolonged, or is paroxysmal in nature.
3. Deterioration of well-being, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the action on the body of bilirubin.

Hepatitis acute and chronic

Hepatitis in patients have acute and chronic forms. In an acute form, they appear in the case of viral liver damage, as well as if there has been poisoning with various types of poisons. In acute forms of the course of the disease, the condition of patients deteriorates rapidly, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into a chronic one. In the acute form, the disease is easily diagnosed and easier to treat. Untreated acute hepatitis easily develops into a chronic form. Sometimes with severe poisoning (for example, alcohol), the chronic form occurs on its own. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, goes slowly, and therefore sometimes remains undiagnosed until the onset of cirrhosis of the liver. Chronic hepatitis is treated worse, and the prognosis for its cure is less favorable. In the acute course of the disease, the state of health worsens significantly, jaundice develops, intoxication appears, the functional work of the liver decreases, and the content of bilirubin in the blood increases. With timely detection and effective treatment of acute hepatitis, the patient most often recovers. With a duration of the disease for more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious disorders in the body - the spleen and liver increase, metabolism is disturbed, complications arise in the form of cirrhosis of the liver and oncological formations. If the patient has reduced immunity, the treatment regimen is chosen incorrectly, or there is alcohol dependence, then the transition of hepatitis to a chronic form threatens the patient's life.

Varieties of hepatitis

Hepatitis A

• in the acute form with jaundice, the liver is seriously damaged;
• with subacute without jaundice, we can talk about a milder version of the disease;
• in the subclinical form, you may not even notice symptoms, although the infected person is a source of the virus and is able to infect others.

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

Hepatitis F

Hepatitis G

Diagnostics

How is hepatitis C treated?

1. The cost of medicines to fight the hepatitis virus is high, and not everyone can buy them.
2. Taking certain drugs is accompanied by unpleasant side effects, including fever, nausea, and diarrhea.

Features of HCV genotypes

• 1a, 1b and 1c;
• 2a, 2b, 2c and 2d;
• 3a, 3b, 3c, 3d, 3e and 3f;
• 4a, 4b, 4c, 4d, 4e, 4f, 4h, 4i and 4j;

How are HCV strains spread around the world?

On the territory of the globe, hepatitis C genotypes are distributed heterogeneously, and most often you can find genotypes 1, 2, 3, and in some areas it looks like this:

• in Western Europe and its eastern regions, genotypes 1 and 2 are most common;
• in the USA, subtypes 1a and 1b;
• in northern Africa, genotype 4 is the most common.

• genotype 1b accounts for ~50% of cases;
• for genotype 3a ~20%,
• ~10% of patients are infected with hepatitis 1a;
• genotype 2 hepatitis was found in ~5% of those infected.

• age of patients. The chance of a cure in young people is much higher;
• it is easier for women to recover than for men;
• the degree of liver damage is important - the favorable outcome is higher with less damage to it;
• the magnitude of the viral load - the less viruses in the body at the time of the start of treatment, the more effective the therapy;
• patient's weight: the higher it is, the more complicated the treatment.

Who is at risk for HCV infection?

• patients receiving blood transfusions;
• patients and clients in dental offices and medical facilities where medical instruments are improperly sterilized;
• due to non-sterile instruments, it can be dangerous to visit a nail and beauty salon;
• lovers of piercings and tattoos can also suffer from poorly processed tools,
• high risk of infection in those who use drugs due to repeated use of non-sterile needles;
• the fetus can become infected from a mother infected with hepatitis C;
• during sexual intercourse, the infection can also enter the body of a healthy person.

How is hepatitis C treated?

What is Sofosbuvir?

The effectiveness of this drug in the fight against HCV was so high that now almost no therapy regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but with complex use it shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which allowed in uncomplicated cases to achieve a cure in just 12 weeks. And this despite the fact that therapy with only interferon and ribavirin was half as effective, and its duration sometimes exceeded 40 weeks. After 2013, each subsequent year brought news of the emergence of more and more new drugs that successfully fight the hepatitis C virus:

• daclatasvir appeared in 2014;
• 2015 was the birth year of ledipasvir;
• 2016 pleased with the creation of velpatasvir.

• Harvoni, a combination of sofosbuvir 400 mg and ledipasvir 90 mg;
• Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

The emergence of generics

Mechanisms of action

1. Sofosbuvir blocks RNA polymerase, thereby inhibiting the replication of the virus.

1. Daclatasvir, ledipasvir and velpatasvir are NS5A inhibitors that interfere with the spread of viruses and their entry into healthy cells.

Generic manufacturers from India

• Hepcvir is manufactured by Cipla Ltd.;
• Hepcinat - Natco Pharma Ltd.;
• Cimivir - Biocon ltd. & Hetero Drugs Ltd.;
• MyHep is a manufacturer of Mylan Pharmaceuticals Private Ltd.;
• SoviHep - Zydus Heptiza Ltd.;
• Sofovir is the manufacturer of Hetero Drugs Ltd.;
• Resof - manufactured by Dr Reddy's Laboratories;
• Virso - Releases Strides Arcolab.

• Natdac from Natco Pharma;
• Dacihep by Zydus Heptiza;
• Daclahep from Hetero Drugs;
• Dactovin by Strides Arcolab;
• Daclawin by Biocon ltd. & Hetero Drugs Ltd.;
• Mydacla by Mylan Pharmaceuticals.

• Ledifos - releases Hetero;
• Hepcinat LP - Natco;
• Myhep LVIR - Mylan;
• Hepcvir L - Cipla Ltd.;
• Cimivir L - Biocon ltd. & Hetero Drugs Ltd.;
• LadyHep - Zydus.

• Velpanat was released by Natco Pharma;
• the release of Velasof was mastered by Hetero Drugs;
• SoviHep V was launched by Zydus Heptiza.

Requirements for generics

1. It is necessary to observe the ratio of the most important pharmaceutical components in the preparation in terms of qualitative as well as quantitative standards.

1. Compliance with the relevant international standards should be adhered to.

1. Mandatory observance of appropriate production conditions is required.

1. The preparations should maintain an appropriate equivalent of the absorption parameters.

Egyptian generics of sofosbuvir

• MPI Viropack, manufactures Marcyrl Pharmaceutical Industries, one of the earliest Egyptian generics;

• Heterosofir is manufactured by Pharmed Healthcare. Is an the only licensed generic in Egypt. On the packaging, under the hologram, there is a hidden code that allows you to check the originality of the drug on the manufacturer's website, thereby eliminating its fake;

• Grateziano, manufactured by Pharco Pharmaceuticals;

• Sofolanork, produced by Vimeo;

• Sofocivir manufactured by ZetaPhar.

Hepatitis Generics from Bangladesh

• Soforal is a generic sofosbuvir containing 400 mg of active ingredient. Unlike traditional packs in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
• Daclavir is a generic of daclatasvir, one tablet of the drug contains 60 mg of the active ingredient. It is also released in the form of blisters, but each plate contains 10 tablets;
• Sofosvel is a generic Epclusa containing sofosbuvir 400mg and velpatasvir 100mg. Pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in vials, the tablets are packed in blisters of 6 pieces in each plate.
• Darvoni is a complex drug that combines sofosbuvir 400 mg and daclatasvir 60 mg. If it is necessary to combine sofosbuvir therapy with daklatasvir, using drugs from other manufacturers, it is necessary to take a tablet of each type. And Beacon combined them into one pill. Packed Darvoni in blisters of 6 tablets in one plate, sent only for export.

Natco Pharma Ltd.

Hetero Drugs Ltd.

Zydus Heptiza

HCV Therapy 2017

• virus genotype;
• the duration of the illness;
• the degree of liver damage;
• presence / absence of cirrhosis, concomitant infection (for example, HIV or other hepatitis), negative experience of previous treatment.

1. Possible treatment regimens proposed by EASL in the case of hepatitis C monoinfection or co-infection with HIV + HCV in patients without cirrhosis and not previously treated:

• for treatment genotypes 1a and 1b can be used:

• in therapy genotype 2 used without ribavirin for 12 weeks:

• during treatment genotype 3 without the use of ribavirin for a period of therapy of 12 weeks, use:

• in therapy genotype 4 you can use without ribavirin for 12 weeks:

1. EASL recommended treatment regimens for hepatitis C monoinfection or co-infection with HIV/HCV in previously untreated patients with compensated cirrhosis:

• for treatment genotypes 1a and 1b can be used:

• in therapy genotype 2 apply:

• during treatment genotype 3 use:

• in therapy genotype 4 apply the same schemes as for genotypes 1a and 1b.

Treatment with modern HCV drugs

• headaches;
• vomiting and dizziness;
• general weakness;
• loss of appetite;
• pain in the joints;
• a change in the biochemical parameters of the blood, expressed in a low level of hemoglobin, a decrease in platelets and lymphocytes.

Contraindications

• individual hypersensitivity of patients to certain ingredients of medicines;

• patients under the age of 18, as there is no accurate data on their effects on the body;

• women who are pregnant and breastfeeding babies;

• women should use reliable methods of contraception to avoid conception during the period of therapy. Moreover, this requirement also applies to women whose partners are also undergoing DAA therapy.

Storage

• order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the place of delivery. Moreover, in most cases, even an advance payment is not required;
• order them through Indian online stores with home delivery. Here you will need an advance payment in foreign currency, and the waiting time will last from three weeks to a month. Plus, the need to communicate with the seller in English will be added;
• go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of verifying the originality of the goods purchased at the pharmacy. To everything else, the problem of self-exportation will be added, requiring a thermal container, a doctor's report and a prescription in English, as well as a copy of the receipt.

Ultrasound of the liver with hepatitis- one of the main stages of diagnosis. Ultrasound allows you to analyze the structure and density of the organ, assess the condition of large vessels and identify pathological changes caused by exposure to the virus.

Hepatitis A, B and C are infectious diseases that lead to damage to the liver and changes in its structure. Chronic forms of hepatitis B and C are especially dangerous. Without proper treatment, they can lead to the development of cirrhosis and malignant tumors. To avoid serious consequences, it is important to consult a doctor at the first signs of the disease:

• pain and heaviness in the right hypochondrium,
• change in the color of stool and urine,
• rise in body temperature to 39 degrees and above,
• loss of appetite
• nausea and vomiting,
• fatigue and headaches.

If hepatitis is suspected, the specialist prescribes an ultrasound of the liver. This simple and affordable study allows you to assess the state of the body in real time. Scanning does not cause discomfort and is absolutely safe for the patient.

In cases of urgent need, ultrasound of the liver is performed at any time, but it is advisable to pay attention to preparation before routine screening.

• A few days before the visit to the clinic, exclude the use of fiber and foods that increase gas formation - raw vegetables and fruits, black bread, legumes, cabbage, milk, carbonated drinks.
• Overweight patients are advised to do a cleansing enema in the morning and evening the day before the ultrasound.
• Refrain from eating for 5-10 hours before scanning.

An experienced ultrasound doctor can identify indirect signs of hepatitis by ultrasound of the liver:

• organ enlargement,
• moderate compaction of the echostructure,
• heterogeneous structure of the parenchyma,
• foci of necrosis and inflammation,
• changes in the vascular pattern and the nature of blood flow,
• dilated bile ducts.

The severity of hepatitis symptoms on liver ultrasound depends on the form and stage of the disease. At the initial stage, the changes are minimal, seals and signs of cirrhosis appear later.

Based on the results of the study, the doctor will determine the degree of spread of the virus and the nature of the course of the disease, offer a new treatment option or adjust the current course of therapy.

Many patients are interested in whether it is possible to accurately establish the diagnosis on ultrasound of the liver with hepatitis C? The liver is one of the main organs of the human body. Its task is to remove accumulated toxins and harmful substances from the body that threaten human health and life. But it so happens that she herself is in danger. One of the most formidable diseases of this important organ is hepatitis C. The main method for diagnosing hepatitis is an ultrasound of the liver, which is indicated at the slightest suspicion of this disease.

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The patient usually complains of:

• malaise;
• nausea;
• pain in the joints;
• odor from the esophagus;
• bitterness in the mouth;
• loss of appetite;
• feeling of heaviness;
• pain in the side (not always).

• liver tumor;
• the presence of cysts;
• cirrhosis.

• legumes;
• milk;
• carbonated drinks;
• fresh vegetables;
• cabbage.

How is the research going?

Hepatitis C is an inflammatory disease of the liver of viral origin, transmitted through the blood, occurring in an acute or chronic form, often having a severe course and often ending in incurable consequences.

Ultrasound examination of the hepatobiliary system is a necessary procedure in the diagnosis of liver diseases. What ultrasound signs of liver inflammation exist and is it possible to detect hepatitis C on ultrasound?

Ultrasound and inflammation

Ultrasound is a highly informative diagnostic method that modern medicine offers us. Serves as an assessment of the state of internal organs, helps to determine the exact diagnosis and makes it possible to monitor the effectiveness of the treatment process. Ultrasound examination is widely used in diagnosing liver pathology.

The liver is an unpaired parenchymal organ and consists entirely of hepatic tissue. The basis of the parenchyma are glandular lobules, which are surrounded by blood collaterals and bile ducts. Healthy tissue on ultrasound looks like a homogeneous, weakly echoic structure, against which vessels and ducts are clearly visible.

The size and density of the organ allow it to reflect ultrasonic waves well, so it is perfectly scanned by an ultrasound machine. To assess the inflammation that occurs with hepatitis, its parameters, wall thickness are measured, the structure of the parenchyma and the state of blood flow are assessed. Ultrasound examination is necessarily included in the complex diagnosis of all hepatobiliary pathologies.

Indications for ultrasound examination of the hepatobiliary system are:

1. Abnormal liver tests (indicates decreased function).
2. Jaundice (yellowing of the skin and mucous membranes).
3. Injuries and diseases of the abdominal cavity.
4. Problems with the gallbladder.
5. Assumption of the oncological process.
6. Feverish state of unknown nature.

Ultrasound detects diffuse changes, including: fibrosis, hypertrophy, sclerosis, parenchymal edema or dystrophy. Such manifestations are characteristic of a number of pathologies, therefore, ultrasound examination fully complements the idea of ​​the state of health.

Ultrasound helps to identify various abnormalities

What are the ultrasound signs of hepatitis and is it always enough to make a diagnosis of one ultrasound examination?

Viral damage leads to inflammation of the liver tissue and functional disorders. Depending on the etiotropic cause and severity of inflammation, the symptoms may be pronounced (acute) or be blurred (chronic). The inflammatory process leads to swelling of the organ and its increase in size, the spleen increases.

On ultrasound, this will manifest itself in a decrease in echogenicity (the ability to conduct ultrasound). On the monitor screen of the device, the inflamed edematous gland will look dark or almost black (depending on the degree of inflammation).

The acute form of the disease proceeds with typical bright symptoms: fever, pain in the right hypochondrium, dysfunction.

The main symptom of acute hepatitis C is yellowing of the skin and mucous membranes, a characteristic increase in the blood of endogenous enzymes ALT, AST and the bile pigment bilirubin, the culprit of "yellowing". There are specific markers of hepatitis C.

Typical but not specific

Can acute hepatitis C be seen on an ultrasound of the liver?

It can be assumed: ultrasound will show an increase in the inflamed organ due to its edema, this sign is typical, but not specific. A similar picture can be provoked by completely different problems. The onset of the disease, its mild course, may not be reflected on the monitor of the ultrasound machine.

The diagnosis of acute hepatitis C is made on the basis of clinical complaints, examination of the patient, history taking and results of biochemical tests.

What does chronic hepatitis C look like on ultrasound?

Is it possible to draw a conclusion about chronic inflammation of the liver based on the results of an ultrasound examination? Theoretically, it is possible, but not always, the initial lesion of the gland by such a study is not always possible to see, additional analyzes are needed.

Additional tests are needed to accurately diagnose the disease.

In some forms of the disease, the liver may slightly increase, but its tissue remains unchanged. Considering that some parameters depend on gender, age, height and constitution, a moderate increase at the beginning, without diffuse changes, can be taken as the norm.

The chronic form often has a latent course and manifests itself when changes in the structure are already quite pronounced and visible on ultrasound.

What is the purpose of ultrasound in viral hepatitis?

In order to determine the state of the organ at this moment, the progression of the disease or to make a conclusion about the effectiveness of the treatment.

• If focal compaction is noted, fibrous-modified areas of tissue, unevenness and tuberosity of the liver, suggest the onset of cirrhosis.

Increased echogenicity (light liver) indicates fatty degeneration of the hepatic parenchyma. fatty hepatosis.

During the study, the parameters are evaluated: the shape, size, structure and condition of the ducts and hepatic collaterals.

The results obtained are compared with the standards and a conclusion is made.

We list the main ultrasound points suggesting hepatitis.

• Size increase.

An unstable and non-specific sign, at the beginning of the disease and with a mild course of the disease, the dimensions may not change. An increase in the organ can be observed in other pathologies, in particular heart disease and vascular disorders. The acute form of the disease is characterized by an increase in the right lobe.

One of the signs of hepatitis is an enlarged liver

• Decreased echogenicity.

A characteristic, but non-specific indicator indicating swelling of the inflamed organ. On the monitor, this is manifested by a darkening, in the conclusion it will be noted by the phrases: hypoechogenicity or anechogenicity (black liver). A similar phenomenon is observed in chronic heart failure (congestive liver).

• Heterogeneity of the hepatic parenchyma.

It does not always indicate viral hepatitis, such changes may indicate sclerosing cholangitis, fatty transformation of the liver tissue, cirrhosis and autoimmune hepatitis.

• Prominent blood vessels.

The consequence of edema of inflamed tissues, against the “dark” background of which the vessels become clearly visible, is a frequent but not constant indicator.

Dangerous "hron"

The chronic form occurs imperceptibly, at the beginning of the disease there are practically no symptoms. On ultrasound, the liver looks normal, no abnormalities in its structure are observed. There may be a slight increase in size, which is not a reason for the diagnosis. In this case, biochemical research is important.

The appearance of visible signs of "chronic" is observed with the further progression of the viral infection. The cause for concern is the identification during the study of ultrasound:

1. A marked increase in the size of the liver (both lobes).
2. The appearance of irregularities of its edges, the fuzziness of their contour (a characteristic sign of cirrhosis).
3. Rounding of the lower edge, increased tissue echogenicity (progression).
4. Heterogeneity.
5. Gradual depletion of the vascular pattern.
6. The decrease in sound conductivity indicates the growth in the parenchyma of dense connective tissue, which is poorly conductive to the knot-wave.

On the basis of a single ultrasound examination of the liver, it is impossible to diagnose hepatitis C; for a final conclusion, an examination and questioning of the patient and important biochemical studies of his blood are necessary. The definition of a certain type of virus must be confirmed by laboratory methods, including PCR (polymerase chain reaction) analysis.

Ultrasound of the liver is a good diagnostic procedure that helps the doctor understand a difficult or controversial situation, make an accurate diagnosis and monitor the effectiveness of the selected treatment.

Ultrasound of the liver

What does a liver ultrasound show?

With ultrasound, the doctor examines the structure, size, lobes and segments of the liver, as well as the gallbladder, common bile duct, intrahepatic ducts, portal vein and intrahepatic vessels.

What can be revealed?

Indications for the procedure

1. Changes in the readings of a biochemical blood test, indicating a disease of the organ.
2. Jaundice of the skin and whites of the eyes.
3. Injury to the abdominal organs.
4. Suspicion of the presence of a tumor or distant metastases.
5. Acute and chronic diseases, diseases of the gallbladder.
6. Fever of unknown etiology.
7. portal hypertension.
8. The period after liver transplant surgery.
9. Puncture for taking a biopsy.

Preparation for the procedure

Obesity and the presence of rare cases of metabolic disorders in a patient, such as hemochromatosis, make it difficult for ultrasound diagnostics.

The condition for performing ultrasound of the liver is the exclusion from the diet of the examined gas-forming food for 3 days

You can not eat cabbage (white, cauliflower, broccoli), legumes (beans, peas, lentils, soybeans), milk and dairy products, carbonated drinks, fruits (apples, pears, plums), flour products.

These recommendations should be taken especially seriously by the elderly and people with digestive disorders, one of whose complaints is flatulence and bloating. This diet eliminates the appearance of swollen intestinal loops that partially cover the liver and other organs, which prevents the ultrasound diagnostician from fully visualizing the organ and can make it difficult to make a diagnosis. Drinking water or tea before the procedure is not prohibited.

• The attending physician, if necessary, prescribes enzyme preparations and enterosorbents.
• For constipation, the patient needs to do an enema in the evening or prescribe a laxative.
• The patient comes to the procedure in the morning on an empty stomach.

How is an ultrasound of the liver

Ultrasound can be performed with the patient standing, lying, sitting. When examining the gallbladder, the patient is asked to lie on his left side. Before the manipulation, the doctor of ultrasound diagnostics applies a special gel to the area being examined. Next, the doctor conducts an examination according to the scheme.

With cirrhosis and in order to examine the blood flow in the portal vein system, it is recommended to use CDM (color Doppler mapping).

Deciphering ultrasound of the liver, normal values

The size of the liver depends on gender, age, constitution

• The weight of the liver is approximately 1400-1600 g.
• Length - 14-20 cm.
• Width - 23-27 cm.
• Right share -< 12,5.
• Left lobe - 6-8 cm.
• The edges are smooth and even.
• The structure is homogeneous.

Deciphering ultrasound of the liver also includes:

• diameter of the common hepatic duct - 3-5 mm;
• the diameter of the inferior pudendal vein is up to 15 mm.

Gallbladder:

• length - 6-10 cm;
• width - 3-5 cm;
• wall thickness - 4 mm;
• diameter of the common bile duct - 6-8 mm;
• the diameter of the lobar bile ducts is 3 mm.

What does granular liver mean?

Granular liver according to ultrasound is considered the norm, if the granularity is small, the structure of the liver is homogeneous and no pathology is revealed. With coarse focal granularity, the question of possible sarcoidosis, metastasis and abscess is raised.

What can ultrasound indicate an enlarged liver in a child?

In children under 7 years of age, hepatomegaly is the norm; on palpation, the edge of the liver can protrude by 1-2 cm.

As the child grows, the organ becomes normal in size.

Pathological enlargement of the liver in children can be with:

• treatment with hepatotoxic drugs;
• congenital infections;
• fatty hepatosis, which develops in children with metabolic disorders and overnutrition;
• chronic diseases of the gastrointestinal tract.

Ultrasound of the liver during pregnancy

Indications:

• cholecystitis, exacerbation;
• chronic hepatitis, aggressive form;
• cholelithiasis.

Ultrasound of the liver for hepatitis C, A and B

In this case, this method is more likely not for diagnosis (laboratory tests are crucial for hepatitis), but for monitoring the course and progression of the disease, the transition to cirrhosis, and allows you to monitor and draw conclusions about the effectiveness of treatment.

For cirrhosis of the liver, the following ultrasound picture is characteristic: focal thickening of the liver, an increase in the size of the liver, areas of fibrosis, the edges of the liver are uneven and bumpy. With cirrhosis, ultrasound of the kidneys and gallbladder is mandatory.

The severity of symptoms depends on the stage of cirrhosis. This can be seen in the systematic examination of such patients. The description of their protocols is different at different times. Often, during ultrasound, these patients have hepatic signs on the examined skin, such as, for example, hepatic dots or asterisks, which patients often confuse with moles.

What may indicate changes in the echogenicity of the liver during ultrasound

After an ultrasound of the liver, the subject is given the result with the final conclusion, a photo is attached (if necessary, and a video). The cost of this procedure depends on the clinic where you will be examined (private or public), the experience of the ultrasound doctor. The price can be overestimated in the presence of a high-quality ultrasound diagnostic device.

An ultrasound examination of the liver allows you to determine the features of the work of the organ. It is carried out in the presence of symptoms of certain diseases, as well as for prophylactic purposes for persons at risk.

Ultrasound is a type of diagnostic procedure when, with the help of the interaction of the apparatus, it becomes possible to study the structure of the liver. The method is reliable, allows you to determine individual indicators and parameters.

Anatomy

The liver is one of the largest organs. Its size and weight vary with age.

In an adult, the weight of the organ ranges from 1300-1800 gr. In newborns, it occupies almost half of the abdominal cavity.

On all sides, the organ is covered with peritoneum. The exception is the gate and the back of the surface. The parenchyma is covered with a fibrous membrane.

The body is responsible for:

• Digestion. Plays an important role in the production of bile.
• Metabolism. All blood passes through the hepatic portal vein. It is responsible for the absorption of carbohydrates, lipids, proteins and their transformation into biologically useful materials.
• Detoxification. Hepatocytes control the quality of blood, remove toxic compounds from it.

Indications

Most often, the procedure is performed on older people, since over the years serious pathologies of the organ may appear. The indications for the procedure are:

1. Yellowness of the skin, whites of the eyes and mucous membranes.
2. Staining of urine in a bright color with simultaneous discoloration of feces.
3. Long-term treatment with the use of serious medications.
4. Radiation effects on the body and chemotherapy.
5. Pain in the abdomen on the right side.
6. The appearance of a feeling of heaviness after eating.
7. Severe abdominal trauma.

A procedure is also prescribed to clarify the presence and size of the focus of inflammation in the liver, which was detected after other research methods. Sometimes there is a suspicion of an abscess in the organs.

Ultrasound allows you to determine the diameter and size of the organ, identify the presence of deviations from the norm and analyze the structure of the tissue.

Contraindications

The procedure is painless, does not imply an aggressive effect on the body through the introduction of special preparations and liquids. The examination is carried out on an outpatient basis.

There are no absolute contraindications to it, but the study is postponed if the patient has taken drugs that can change the clinical picture. Perhaps the appearance of infectious diseases of the skin in the area of ​​the projection of the liver. Then, to prevent the spread of the disease, the date of the ultrasound is postponed.

Contraindications include the patient's use of alcoholic beverages, food, which cause flatulence. In this case, the possibility of making an erroneous diagnosis increases.

Preparing the patient for the procedure

It is needed to obtain more accurate information about human health. At the time of the examination, there should be no gas in the intestines, so an examination on an empty stomach or with a change in diet is recommended.

A few days before the ultrasound, fiber, cabbage, whole milk, legumes, fruits and bread are excluded.

Sometimes a doctor prescribes a sorbent and an enema. Drugs such as Smecta, Activated charcoal, Espumesan will help reduce the amount of gases in the intestines. It is possible to take enzyme preparations, for example, Pancreatin and Creon.

Video on how to prepare for an ultrasound of the liver:

Methodology

The duration of the procedure is from 15 to 30 minutes. The person is placed on the couch in the supine position. Sometimes the doctor may ask you to take a different position.

After the procedure, you can immediately return to your daily activities, drive a car. In emergency situations, ultrasound of the liver is performed without preparation.

Normal organ sizes in adults and children

The dimensions of a healthy liver in adults are as follows:

• The thickness of the right lobe is 110-130 cm, the length is 110-150 mm.
• The maximum vertical oblique dimension is up to 150 mm.
• The thickness of the left lobe is 50-70 mm, the height is up to 100 mm.

When studying the dimensions, uniformity, clarity of contour, and the condition of the veins are immediately taken into account. The liver in men and women has the same parameters. In this case, the maximum size of the hepatic artery reaches a maximum of 13 mm, the portal vein - 11-18 mm, the hepatic veins up to 10 mm.

In children, the examination takes into account age:

But these data are for informational purposes, since only a hepatologist or a general practitioner can judge deviations and features.

What does an ultrasound of the liver show: decoding

The structure must be evaluated. The edge of the liver should be even. After that, the sizes of the shares are examined. After that, the parenchyma of the gland is analyzed for the presence of nodes, seals and calcifications, which form changes in the signal received by the apparatus.

By amplification or weakening of ultrasonic waves, the doctor of functional diagnostics recognizes the presence of liquid and dense formations.

Anomalies of development

With the help of an ultrasound machine, a large number of anomalies can be detected, including congenital liver hypoplasia in children.

The hardware diagnostic method allows you to determine:

1. Agenesis of the right lobe of the liver and the left. The latter is more common. With a disease, one lobe or part of it is missing. Additionally, other diagnostic methods are used to make a diagnosis.
2. Riedel's share. It is characterized by a change in the shape of the organ. The doctor can detect the formation of a language form.
3. Additional shares. They are located above the diaphragm or in the hernial sac. They are connected to the main organ by a fibrous band.
4. Cystic and polycystic diseases. the latter appear on the walls of organs during fetal development. Diseases may not manifest themselves for many years.

Diffuse parenchymal changes

With running processes, they indicate the presence of a serious pathological process. Anomalies and changes in the liver tissues can occur with violations and severe damage to the organ.

Usually, with diffuse changes in the parenchyma, deformation or thinning of the walls of the parenchyma and surrounding tissues is formed. This leads to a violation of the integrity and normal functioning of the liver.

cysts

This is a focal cavitary change in the liver, manifested by pain, asymmetry of the abdomen, nausea. With the help of ultrasound, such benign formations can be found in various segments, lobes and ligaments of the liver. The diameter is usually from a few millimeters to 25 cm.

In the liver, cysts are found in 0.8% of the population. It is more common in women than in men. This disease is often combined with cholelithiasis, liver cirrhosis, polycystic ovaries.

Congenital

This type is formed as a result of a violation of the development of the ducts. It turns out to be blocked, so bile cannot come out of it. Gradually, a cavity is formed. The pressure increases so much that further flow of the liver becomes impossible.

Congenital cysts have their own capsule. This distinguishes them from other types. On ultrasound, both single and multiple forms can be detected.

Fluid formations are usually anaechogenic. If the fluid is heterogeneous, then the echogenicity may be different.

Echinococcal

There are two forms of the disease:

1. The hydatid view is shaped like cysts.
2. Alveolar - tumor-like formations.

Sometimes both types are combined. On ultrasound, the doctor will see rounded, limited areas of altered liver tissue that contain fluid. Additionally, an immunological study is prescribed to clarify the diagnosis.

traumatic

They are spherical or oval in shape, free from echoes. Traumatic develop after a central or subcapsular rupture of the liver, may appear after treatment of a liver abscess.

Such a benign formation appears with strong blows, falls, fractures of the ribs.

Tumor formations

With the help of ultrasound of the liver, both benign and malignant tumors can be detected.

The first type is an adenoma. It looks on the device as a simple formation with smooth contours.

Hemangiomas are formed from vascular tissue. On ultrasound, the picture is represented by a formation with uneven contours and a heterogeneous structure.

It is possible to identify liver lipoma. This is a fatty tumor that is similar to hemanigoma and metastases. A rare formation is biliary cystadenoma. Ultrasound shows that the walls of the cyst have a rich blood supply and multiple papillary foci.

In malignant tumors, ultrasound confirms the presence of dense formations. The technique allows to establish the presence of such dangerous diseases as carcinoma, angiosarcoma, hepatoblastoma. In the primary lesion, the ultrasound picture is diverse.

Suspicion of the presence of a tumor can cause:

• seals in the area of ​​the branches of the portal vein,
• changes in the vascular pattern,
• an increase in the size of the body,
• rounded bottom edge
• the effect of weak conduction of ultrasound.

Due to the attenuation of the ultrasonic waves, the image of the diaphragm becomes blurred.

Why is the organ enlarged?

An enlarged liver is said to be when its size at the intersection of the organ with the right midclavicular line starts from 12 cm, and the left lobe is in the epigastric region. Such formations can be provoked by both education and:

An increase can be assumed by the appearance of heaviness in the right side, emotional instability, a change in color and feces. Dangerous consequences are oncological processes, cirrhosis and the development of liver failure.

The concept of graininess

The liver consists of cells that are slightly flattened. Thanks to this, we can talk about the porous structure of the organ. This is necessary for the full functioning of the body.

Normally, the internal structure of the liver is fine-grained and soft.

Pathological processes develop gradually.

First, medium-grained or coarse-grained appears. The latter indicates the appearance of hepatitis, severe obesity or the presence of diabetes.

With ultrasound, you can see a significant increase in segments of the structure of the liver and heterogeneity of the lymph nodes.

Examination with elastography

This method is used to assess the severity of fibrosis. With conventional ultrasound, the first stages of fibrosis, cirrhosis and hepatitis look the same. Previously, a liver biopsy was used to make an accurate diagnosis. This procedure is expensive and has many side effects.

Elastographic technique allows to make an adequate diagnosis. Transient ultrasonic elastometry is performed through the intercostal spaces.

A special device has an ultrasound sensor with a source of low-frequency vibrations. They reach the desired tissues and then transform into electromagnetic waves. This method determines the wave distribution velocity, which depends on the elastic component.

With the method, two modes are simultaneously performed, thanks to which the ultrasound picture of the liver and color mapping, which evaluates the density of the tissue, are visible. This research method gives a complete picture of the pathological process developing in the liver.

Where can the examination be done?

It is possible to carry out a conventional ultrasound of the liver both in the clinic and during treatment in a hospital. Usually, you should sign up for the procedure in advance at the registry office or through the website of the selected institution. Diagnosis is also carried out in various medical centers that are in all major cities.

Price

The most expensive research method is ultrasound with elastography. In Moscow and St. Petersburg 2-3 years ago it could be completed for 7 thousand rubles. Today, prices are more democratic, so the average procedure will cost 4 thousand.

Prices for a classic ultrasound examination start at 700 rubles.

What is hepatitis?

Hepatitis is an inflammation of the tissue or, in other words, the parenchyma of the liver. Moreover, this inflammation affects the entire liver tissue, therefore it refers to diffuse diseases. Unlike focal diseases, which do not affect the entire tissue of the organ, but some part of it (the focus).

The word "hepatitis" itself comes from the Greek "hepar", in the genitive case - "hepatos", which means "liver". And the ending "it", in all medical terms, indicates that we are talking about inflammation. Yet the word, as you now understand, is translated as "inflammation of the liver." Which is quite true.

According to the nature of the course, all hepatitis is divided into acute and chronic.

Acute hepatitis

An acute course is a rapid development of inflammation, occurring with severe symptoms characteristic of any inflammation:

• temperature increase
• swelling of an inflamed organ
• violation of the function (work) of the inflamed organ

Therefore, in acute hepatitis, a person's body temperature rises, he feels pain in the right hypochondrium (where the liver is located), the liver enlarges due to swelling of the entire parenchyma. Liver function also suffers, which can be determined by doing blood tests.

And outwardly, a violation of liver function can be seen from the yellowness of the skin and mucous membranes that has appeared. This is the so-called jaundice.

Is it possible to see acute hepatitis on ultrasound?

Ultrasound signs of acute hepatitis exist. But the trouble is that these signs are not specific. What does it mean? This means that the same symptoms can be observed in other diseases.

Therefore, it is impossible to make a diagnosis of acute hepatitis, relying only on ultrasound. In order to make a diagnosis of acute hepatitis, you still need to examine the patient, ask him questions, and do blood tests.

On ultrasound, you can see the following signs of acute hepatitis:

1. An increase in the liver - a sign that is not permanent and not specific Not permanent, because at the beginning of the disease and with a mild degree of the disease, there may not be an increase in the liver. And not specific - because the liver can be enlarged in many diseases, and not just in acute hepatitis. In acute hepatitis, the right lobe increases more significantly than the left. 2. Diffuse decrease in the echogenicity of the liver In simple terms, the liver on the screen of the ultrasound machine becomes darker than usual. Such a dark image of the organ is due to its edema. Edema is the saturation of an organ with fluid. A liquid perfectly conducts ultrasound and practically does not reflect it. Therefore, the liquid on the screen looks dark (not echogenic or anechoic), almost black. And organs saturated with liquid (edematous) are darker than normal (reduced echogenicity, hypoechoic). You can read about what echogenicity is in the article “What does echogenicity mean?” This increases the sound conductivity of the liver tissue. And this is understandable: the more the body contains fluid, the better it conducts ultrasound. A diffuse decrease in echogenicity is also not a specific sign, since it is characteristic not only for acute hepatitis, but also for some other diseases. For example, for congestive liver in chronic heart failure. With heart failure, edema of many organs and the liver is also observed - including. Of course, an experienced ultrasound doctor will always distinguish a dark congestive liver from a dark inflamed liver by other signs. But, nevertheless, this symptom is not specific for acute hepatitis. And not permanent. Since with a mild degree of the disease, the edema may not be pronounced and the liver will remain normal echogenicity. 3. Heterogeneity of the liver tissue This sign indicates that different areas in the liver tissue are subject to edema to varying degrees. Areas of tissue more saturated with edematous fluid appear darker. Areas of the parenchyma less saturated with edematous fluid are lighter. This sign is also not specific and not constant. 4. More pronounced vascular pattern of the liver This symptom is also a consequence of edema of the liver parenchyma. As the liver tissue becomes darker, the dense walls of the vessels are more clearly visible against its background. This effect is observed only when tissue edema is well expressed. It is also not constant and not specific. It is also important that the vascular pattern in acute hepatitis is visible too well, but there is no deformation and distortion of this pattern, which happens with other liver diseases. 5. With a sufficiently pronounced edema, the liver capsule is too clearly visible. The image of the capsule is echogenic, that is, light, and against the background of a dark liver it can be seen very well. Better than when the liver has normal echogenicity.

chronic hepatitis

Chronic hepatitis is a long-term disease that lasts for years, during which periods of calm and relative well-being are replaced by exacerbations.

Speaking of chronic hepatitis, it should be noted that the initial stages and mild degree of this disease, as a rule, are not determined by ultrasound.

The liver in these cases looks normal, its structure is not broken. There may not be a large increase in the size of the liver. But this is not enough to suspect chronic hepatitis.

Therefore, at this stage, blood tests are of particular importance, which in the early stages of hepatitis indicate impaired liver function, with its (still) normal appearance preserved.

With further progression of this disease, its ultrasonic signs also appear. Which?

1. An increase in the size of the liver, both of its right and left lobe 2. The contour of the liver remains smooth and clearly visible Only with severe hepatitis, turning into cirrhosis, there is an uneven and fuzzy contour. 3. The lower edge of the liver becomes more rounded 4. The echogenicity of the tissue increases Moreover, the more pronounced the hepatitis, the greater the echogenicity of the liver. An increase in echogenicity indicates that the amount of dense connective tissue in the liver tissue increases. And this is a sign of any chronic inflammation. 5. Heterogeneity of the parenchyma This symptom may be absent for a long time, and appear only in the later stages of the disease. The more pronounced the process of chronic inflammation, the greater the heterogeneity of the tissue. 6. The vascular pattern of the liver is gradually depleted. This happens because the small vessels of the liver are becoming worse and worse. This effect is explained by the fact that a more echogenic, lighter liver parenchyma masks the thin walls of small vessels. 7. The impoverishment of the vascular pattern occurs due to the deterioration of the visibility of the hepatic veins and small branches of the portal vein, while the large branches of the portal vein are often more clearly visible. This effect is explained by the fact that in some forms of chronic hepatitis there is a more intensive growth of connective tissue around the portal vessels. At the same time, large branches are visible more clearly than usual. 8. The sound conductivity of the organ decreases. This effect is caused by the fact that during chronic inflammation in the parenchyma of the organ, dense connective tissue grows, which poorly conducts ultrasonic waves. You can read about what sound conductivity is in the article “What is sound conductivity?”

As you can see, there are quite a few ultrasound signs that allow you to see hepatitis on ultrasound. And, although these signs are characteristic not only for hepatitis, an experienced doctor will take into account their combination and compliance with the patient's complaints, receive confirmation in blood tests and make the correct diagnosis.

But the correct diagnosis is the very first and main step to the correct and effective treatment.

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Indications for research and diseases detected by ultrasound

Such diagnostics should be carried out not only if hepatitis is suspected, it helps to detect other liver pathologies. Indications for ultrasound of the liver are as follows:

Suspicion of an abscess;

Abdominal trauma;

Monitoring the course of treatment;

preventive goals.

Ultrasound diagnostics reveals the following diseases:

Acute hepatitis and its chronic form;

tumors;

Cirrhosis of the liver;

Hemangiomas and hematomas.

With the help of ultrasound, all changes in the structure of the liver are determined, which allows the doctor to determine the presence or absence of hepatitis. For complete certainty, a blood test is performed, which provides additional data necessary to establish an accurate diagnosis.

Preparing for an ultrasound of the liver

Before the examination, refrain from eating, especially if it is planned in the morning. You should also free the intestines from gases to prevent interference during the ultrasound. To do this, follow a special diet for 3 days. Give up foods such as beans, peas, milk, fresh vegetables, cabbage, carbonated drinks.

Ultrasound examinations can be difficult for overweight patients. Therefore, a day before the diagnosis, they are recommended to conduct a cleansing enema (in the evening and in the morning). For more information on preparing for Ultrasound of the liver with hepatitis you get from your doctor.

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When is ultrasound prescribed for hepatitis C?

This diagnostic method is very informative, absolutely safe and painless. Ultrasound of the liver allows you to detect even minor changes in the organ and make an accurate diagnosis. An ultrasound scan of the liver shows the doctor the extent of the infection, the general condition, the functioning of the organ, and the nature of the lesion.

If hepatitis C is diagnosed, then the patient is assigned an additional ultrasound with color Doppler mapping. This kind of ultrasound allows specialists to trace the work of the vessels that feed the gland, the blood flow in dynamics. This method makes it possible to track the movement of blood through the vessels of the liver in real time and in a color image.

A diagnostic specialist will see the direction of fluid movement and speed, as well as track places where there is no blood supply. Ultrasound combined with color Doppler imaging is one of the most informative, popular and common types of liver disease diagnostics. To form a complete picture of the nature and extent of the disease, in addition to ultrasound, a patient's blood test is prescribed.

What does ultrasound show?

The patient usually complains of:

• malaise;
• nausea;
• pain in the joints;
• yellowness or gray tint of the skin and whites of the eyes;
• odor from the esophagus;
• bitterness in the mouth;
• loss of appetite;
• feeling of heaviness;
• pain in the side (not always).

In this case, the doctor may suspect hepatitis C and prescribe an ultrasound of the abdominal organs. But these symptoms do not always indicate this disease. Ultrasound can accurately determine the presence or absence of a viral infection or other liver pathologies. The following diseases can be determined by ultrasound:

• hepatitis C (its acute or chronic form);
• liver tumor;
• various hematomas and hemangiomas;
• the presence of cysts;
• cirrhosis.

Since the liver is closely connected by vessels with such an abdominal organ as the gallbladder, a liver scan can reveal cholelithiasis or cholecystitis.

Moreover, with a disease such as hepatitis C, the condition of the gallbladder plays an important role, therefore, if this pathology is suspected, it is also examined. With hepatitis, problems with general health are often associated with the functioning of the gallbladder. Such a symptom as pain in the pathology of the gland rarely appears, but the gallbladder signals with pain about violations in the diet. Cholecystitis can be a consequence or a complication of hepatitis C, which will require separate treatment.

What does ultrasound show in hepatitis? Ultrasound of the liver can help diagnose the various stages of hepatitis C and cirrhosis. The monitor shows what the liver looks like, its size, density, foreign inclusions and other various parameters of the organ. Each of the diseases, including hepatitis C and its various stages, has its own special ultrasound signs.

The results of this study can be seen:

1. In acute hepatitis C, ultrasound shows a slightly enlarged organ, its surface is smooth and even. Several foci of necrosis are visible, foci of fatty degeneration are detected. The blood flow is clearly visible, which is not disturbed.
2. Chronic hepatitis on ultrasound is determined by the following indicators. A large number of foci of necrosis. The liver tissue is almost destroyed, in its place - overgrown connective tissue. Fibrous bands are visible.
3. With cirrhosis of the liver, ultrasound will show circulatory disorders, varicose veins and the formation of additional vessels, through which some of the blood circulates, bypassing the gland.

Thanks to ultrasound diagnostics, it is possible to diagnose hepatitis at an early stage and begin treatment immediately, without waiting for complications and cirrhosis. The main thing that ultrasound can show in the initial stage of the disease is that the size of the liver in hepatitis immediately becomes enlarged.

But the danger and insidiousness of this disease lies in the fact that in the early stages it is most often asymptomatic, although inflammation in the liver due to infection is in full swing.

Disturbing signs may appear only in the later stages of the disease: with an exacerbation of chronic hepatitis C or cirrhosis of the liver. Therefore, it is recommended to be examined regularly in order to monitor the condition of the liver and the behavior of the viral infection.

How to prepare for an ultrasound of the liver?

In order for the ultrasound readings to be as accurate and informative as possible, you should properly prepare for the procedure. In this case, it is recommended to refrain from eating for several hours. In order to free the abdominal cavity from excess gases, you should not consume the following products within 3 days before the procedure:

• legumes;
• milk;
• carbonated drinks;
• fresh vegetables;
• cabbage.

The day before the study, a cleansing enema should be performed (especially for those patients who are overweight). In each case, the doctor may recommend taking any other measures in order to properly prepare for ultrasound in hepatitis C.

How is the research going?

Ultrasound of the liver is performed with an ultrasonic sensor. The patient should lie down, hold his breath. At this time, the doctor, passing the sensor over the abdomen, receives data on the organ under study on the monitor screen.

The real-time screen reflects the state of the liver of the subject, its structure, size and other parameters. Most often, 2D ultrasound is used in the study of the liver. This device displays a two-dimensional, flat black and white picture on the screen, which has a height and length. Recently, three-dimensional ultrasound devices - 3D and 4D - are becoming more and more widespread.

Both of these types of research differ from the previous one in volumetric image and color. They differ from each other in that a 3D picture shows a three-dimensional image of an organ from one point of view. When conducting a 4D study, the doctor can expand the three-dimensional image of the organ and examine it from all sides, so the parameters of the liver will be visible very well.

When is 3D and 4D examination indicated? Sometimes a two-dimensional ultrasound is enough to make an accurate diagnosis, but there are times when the diagnosis needs to be clarified, supplemented or confirmed. Before a planned surgical intervention, a three-dimensional ultrasound is indicated.

Preparation for such an ultrasound should be thorough, in compliance with all of the above recommendations and one more important point: if an X-ray examination was performed the day before, then it is necessary to inform the doctor about this, as the results may be distorted.

Indications

Indications for ultrasound of the gallbladder and liver:

• yellowness of the skin and mucous membranes;
• bright yellow urine or an increase in the concentration of bile pigments in it;
• elevated levels of bilirubin in plasma;
• deviation of indicators of transaminases in the blood;
• dull pain or discomfort in the right hypochondrium;
• assumption of the presence of neoplasms;
• clarification of the presence of metastases in the organ, their localization, number;
• differential diagnosis of lesions of the gland and gallbladder;
• abdominal trauma;
• Ultrasound control during operations;
• preventive examination;
• assessment of the adequacy of treatment.

Contraindications

Ultrasound is not indicated if there is:

• purulent damage to the skin;
• burns in the study area;
• patient refusal.

Emergency ultrasound of the liver has no contraindications.

Training

In order for the survey to show reliable results, it is required to follow the preparation rules:

• Exclude the use of cabbage, fruits, dairy, black bread, yeast products and carbonated drinks 2-4 days before the examination.
• A fractional diet is shown with a frequency of eating 4-6 times a day.
• The volume of fluid consumed is recommended to be up to 1.5 liters per day.
• It is necessary to drink enzymes for chronic digestive dysfunction.
• An hour before the examination, in case of constipation or bloating, give an enema.
• The procedure is carried out on an empty stomach.
• An emergency examination does not require preparation.
• Within 2 days after radiopaque or endoscopic studies of the stomach, the procedure is not performed.
• After laparoscopy, the examination is carried out after 2-6 days.
• It is not recommended to stop taking any medications.

Decryption

The size and boundaries of the liver are one of the main characteristics of the organ. Indicators depend on age, gender, complexion. In men, volumes, mass and parameters are greater than in women. The right and left lobes are measured separately. In the process of ultrasound, the structure of the organ, which is normally homogeneous, the homogeneity of tissues, the bile ducts, the vascular pattern, and the size of the lobes, is studied.

What does it show?

The results and signs of ultrasound show the presence of pathologies:

• Spots on the liver - areas of increased echogenicity. May be the result of enzyme dysfunction, a sign of cysts, hepatosis or hemangiomas, Giardia lesions.
• An echopositive formation in the liver is a sign of hemangiomas, cancer, metastases, abscesses, cysts, fatty inclusions, adenomas, and focal hyperplasia.
• Acute and chronic hepatitis. Ultrasound of the liver with hepatitis has no characteristic changes. Possible: inhomogeneity of the structure, areas of reduced echogenicity due to tissue edema, enlargement of the organ, increase in parameters, medium-grained structure of the liver, impoverishment of the vascular pattern. The progression of the disease changes the echogenicity of the tissue.
• Cirrhosis of the liver. Ultrasound will show a violation of the structure of the vessels and tissue of the gland, the processes of restoration and sclerosis of cells. The organ increases in volume in the early phases of the disease and decreases in the latter. The ratio of the sizes of the shares changes: the left and tail parts increase, the right part decreases. The contour becomes uneven and bumpy, regeneration nodes larger than 5-15 mm are determined. The parenchyma is heterogeneous, the vascular pattern is depleted, criteria for increased pressure in the portal vein system appear.
• portal hypertension. Criteria include: an increase in the parameters of the organ, restoration of the throughput function of the umbilical vein, an increase in the lumen of the portal vein, a change in the caliber of the splenic vein, splenomegaly. Hepatosis or fatty infiltration is accompanied by a diffuse increase in tissue echogenicity, an increase in size, and softening of the vascular pattern. There are also areas of reduced echogenicity, distal attenuation of the echo signal, and a change in the oblique vertical dimension. The "white liver" is visualized on ultrasound.
• Budd-Chiari syndrome. Deficiency of vein image, tortuosity and decrease in the diameter of vessels, enlargement of the caudate lobe, venous detours, absence of veins.
• Metastases. The histological structure does not correspond to echographic characteristics.
• Hepatocellular carcinoma. Hypo- or hyperechoic nodes are found.
• Hemangiomas. The small size of the formation up to 4 cm, a uniform increase in the echogenicity of the structure, the clarity of the contours, typically located under the capsule of the right lobe.
• Cysts and cystic structures. Solitary, with the inclusion of fluid formations of various locations are observed. Single cysts have a rounded shape. Sizes range from a couple of millimeters to many centimeters.
• Calcifications. On ultrasound, they are represented by dense single or numerous formations surrounded by sound tissue.

Assessment of the state of the liver by ultrasound requires skills and experience. When a patient seeks advice, every doctor should be able to understand the meaning of the terms and their interpretation. Only after a complete clinical examination, taking into account the complaints and the patient's condition, obtaining the results of additional examination methods, is the appointment of an appropriate treatment regimen and lifestyle correction carried out.